Departments of Obstetrics and Gynaecology (Vélez) and Public Health Sciences (Vélez), Queen's University, Kingston, Ont.; ICES Central (Slater, Griffiths, Shah, Walker, Green), Toronto, Ont.; Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto; Chiefs of Ontario (Sutherland, Jones), Toronto, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Health Services and Policy Research Institute (Green), Queen's University, Kingston, Ont.
CMAJ Open. 2020 Mar 19;8(1):E214-E225. doi: 10.9778/cmajo.20190195. Print 2020 Jan-Mar.
In Canada, increasing numbers of women, especially First Nations women, are affected by diabetes during pregnancy, which is a major risk factor for adverse maternal and neonatal outcomes. The aim of this study was to examine temporal trends in pregnancy outcomes and use of health care services in a population-based cohort of First Nations women compared to other women in Ontario according to diabetes status during pregnancy.
Using health administrative databases, we created annual cohorts of pregnant women from 2002/03 to 2014/15 and identified those with preexisting diabetes and gestational diabetes. We used the Indian Register to identify First Nations women. We estimated rates of adverse maternal and infant outcomes, and measures of use of health care services in each population.
There were 1 671 337 deliveries among 1 065 950 women during the study period; of these deliveries, 31 417 (1.9%) were in First Nations women, and 1 639 920 (98.1%) were in other women. First Nations women had a higher prevalence of preexisting diabetes and gestational diabetes than other women in Ontario. First Nations women with preexisting diabetes had higher rates of preeclampsia (3.2%-5.6%), labour induction (33.4%-42.9%) and cesarean delivery (47.8%-53.7%) than other women in Ontario, as did First Nations women with gestational diabetes (3.2%-4.7%, 38.5%-46.9% and 41.4%-43.4%, respectively). The rate of preterm birth was similar between First Nations women and other women in Ontario. Although First Nations women had a higher rate of babies who were large for gestational age than other women, regardless of diabetes status, obstructed labour rates were similar for the 2 cohorts. Almost all First Nations women, regardless of diabetes status, were seen by a primary care provider during their pregnancy, but rates of use of specialty care were lower for First Nations women than for other women. Fifteen percent of all pregnant women with preexisting diabetes visited an ophthalmologist during their pregnancy.
Our results confirm disparities in maternal and neonatal outcomes between First Nations women and other women in Ontario. Access to primary care for pregnant women seemed adequate, but access to specialized care, especially for women with preexisting diabetes, needs to improve.
在加拿大，越来越多的女性，尤其是第一民族女性，在怀孕期间受到糖尿病的影响，这是母婴不良结局的主要危险因素。本研究旨在根据孕期糖尿病状况，比较安大略省第一民族女性与其他女性的妊娠结局和医疗服务使用的时间趋势。
使用健康管理数据库，我们创建了 2002/03 年至 2014/15 年期间每年的孕妇队列，并确定了那些患有糖尿病前期和妊娠期糖尿病的孕妇。我们使用印第安人登记册来识别第一民族妇女。我们估计了每个群体的不良母婴结局发生率和医疗服务使用的衡量指标。
在研究期间，1065950 名妇女中有 1671337 名分娩，其中 31417 名（1.9%）是第一民族妇女，1639920 名（98.1%）是其他妇女。与安大略省的其他女性相比，第一民族女性患有糖尿病前期和妊娠期糖尿病的比例更高。患有糖尿病前期的第一民族妇女子痫前期（3.2%-5.6%）、引产（33.4%-42.9%）和剖宫产（47.8%-53.7%）的发生率均高于安大略省的其他女性，患有妊娠期糖尿病的第一民族妇女也如此（分别为 3.2%-4.7%、38.5%-46.9%和 41.4%-43.4%）。早产率在第一民族妇女和安大略省的其他妇女之间相似。尽管无论糖尿病状况如何，第一民族妇女的巨大儿发生率均高于其他妇女，但两组的产程阻滞率相似。几乎所有的第一民族妇女，无论是否患有糖尿病，在怀孕期间都接受了初级保健提供者的治疗，但接受专科治疗的比例均低于其他妇女。15%患有糖尿病前期的孕妇在怀孕期间会看眼科医生。
我们的研究结果证实了安大略省第一民族妇女与其他妇女在母婴结局方面存在差异。孕妇获得初级保健的机会似乎足够，但获得专科保健的机会，尤其是患有糖尿病前期的妇女，需要改善。
